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Left ventricular responses to upright isometric handgrip and deadlift in men with coronary artery disease
Insights
Isometric exercise may be safe for coronary artery disease (CAD) patients, as it did not significantly alter global left ventricular (LV) function. However, it can worsen LV wall motion abnormalities in CAD patients.
Area of Science:
- Cardiology
- Exercise Physiology
- Cardiac Rehabilitation
Background:
- Isometric exercise is often avoided in coronary artery disease (CAD) patients due to concerns about increased blood pressure impacting left ventricular (LV) function.
- Patients with CAD often have reduced resting LV ejection fraction and may exhibit wall motion abnormalities.
Purpose of the Study:
- To compare cardiovascular and LV responses to isometric handgrip and deadlift exercises in normal men and exercise-trained CAD patients.
- To assess the safety and effects of submaximal isometric exercise on global and regional LV function in CAD patients.
Main Methods:
- 10 normal men and 14 CAD patients performed 3-minute handgrip and deadlift exercises at 30% maximal effort.
- Cardiovascular parameters (heart rate, blood pressure) and LV function (ejection fraction, wall motion) were assessed using radionuclide angiography and ECG.
- Measurements were taken at rest and during the final 60 seconds of each exercise bout.
Main Results:
- Both groups exhibited similar significant increases in heart rate and blood pressure during exercises, with greater responses during deadlift.
- No significant changes in global LV ejection fraction were observed in either group during isometric exercises.
- LV wall motion abnormalities, present at rest in CAD patients, worsened during both handgrip and deadlift exercises.
Conclusions:
- Submaximal isometric exercise elicits comparable cardiovascular responses in normal individuals and exercise-trained CAD patients.
- Global LV function remains stable during isometric exercise despite increased afterload, but regional LV wall motion is impaired in CAD patients.
Abstract:
Isometric exercise is usually discouraged for patients with coronary artery disease (CAD) because of the possible adverse effects of increased blood pressure on left ventricular (LV) function. Cardiovascular and LV responses to upright handgrip and deadlift were compared in 10 normal men (mean age 52 years) and 14 men (mean age 54 years) with documented CAD or myocardial infarction who were in a supervised exercise program. Handgrip and deadlift were each performed at 30% maximal effort for 3 minutes. LV technetium-99m multigated radionuclide angiograms, electrocardiogram and blood pressure were measured during the final 60 seconds. CAD patients had a significantly lower LV ejection fraction at rest (41%) than normal subjects (57%). Both groups showed equal and significant increases in heart rate, systolic and diastolic pressure during handgrip and deadlift. These responses were all significantly greater in both groups during deadlift. No significant changes in LV ejection fraction occurred in either group during handgrip or deadlift. LV wall motion abnormalities were present in 9 of 14 CAD patients at rest and increased with handgrip (11 men) and deadlift (13 men). No LV abnormalities occurred in normal subjects. These data indicate cardiovascular responses are similar in normal and exercise-trained CAD patients during upright submaximal isometric exercise using small or large muscle groups. Radionuclide measurements of global LV function remain stable in both groups, during similar conditions of increased systolic pressure afterload. However, LV wall motion abnormalities are aggravated in CAD patients during isometric exercise.